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Endoscopic extraction of Fasciolopsis buski presenting as acute upper GI bleeding in a child
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Endoscopic extraction of Fasciolopsis buski presenting as acute upper GI bleeding in a child
Figure 1. A 4 3-cm Fasciolopsis buski in the external environment. Yellow arrow indicates the ventral sucker.
An 8-year-old girl from rural North India presented to our emergency department with 3 bouts of hematemesis over 1 week. Her last bout of bleeding was 48 hours before admission. She was recovering from a concomitant acute hepatitis B infection (hepatitis B surface antigen positive, immunoglobulin M anti-hepatitis B core positive) without any drug intake or coagulopathy. She had a pond fish cultivation background and had a history of unwashed water chestnut ingestion. Examination revealed normal growth parameters, hyperdynamic circulation, significant pallor, icterus, and soft, nontender hepatomegaly. Her workup revealed microcytic hypochromic anemia (hemoglobin: 5.5 g/dL) and normal coagulation parameters. After packed red blood cell transfusion and resuscitation, duodenoscopy at 48 hours revealed a live 4-cm long, flesh-colored, tongue-shaped organism in the second part
of duodenum that was gently removed with endoscopy grasping forceps (Fig. 1; Video 1, available online at www.giejournal.org). The organism survived in the external environment for 60 seconds. No other lesions were seen. Stool examination demonstrated eggs of Fasciolopsis buski (intestinal fluke). She was treated with 3 days of oral praziquantel 25 mg/kg and remained asymptomatic during 1 year of follow-up. To our knowledge, this is the first report of F buski presenting as acute upper GI bleeding in a child. Mucosal erosions or ulcers may develop from the ventral sucker. Public awareness, hygiene education, and antihelminthic therapy need to be emphasized in endemic areas. DISCLOSURE All authors disclosed no financial relationships relevant to this publication.
This video can be viewed directly from the GIE website or by using the QR code and your mobile device. Download a free QR code scanner by searching “QR Scanner” in your mobile device’s app store.
www.giejournal.org
Moinak Sen Sarma, MD, Surender Kumar Yachha, DM, Anshu Srivastava, DM, Ujjal Poddar, DM, Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India http://dx.doi.org/10.1016/j.gie.2015.05.030
Volume 82, No. 4 : 2015 GASTROINTESTINAL ENDOSCOPY 743
Endoscopic extraction of Fasciolopsis buski presenting as acute upper GI bleeding in a child
Figure 1. A 4 3-cm Fasciolopsis buski in the external environment. Yellow arrow indicates the ventral sucker.
An 8-year-old girl from rural North India presented to our emergency department with 3 bouts of hematemesis over 1 week. Her last bout of bleeding was 48 hours before admission. She was recovering from a concomitant acute hepatitis B infection (hepatitis B surface antigen positive, immunoglobulin M anti-hepatitis B core positive) without any drug intake or coagulopathy. She had a pond fish cultivation background and had a history of unwashed water chestnut ingestion. Examination revealed normal growth parameters, hyperdynamic circulation, significant pallor, icterus, and soft, nontender hepatomegaly. Her workup revealed microcytic hypochromic anemia (hemoglobin: 5.5 g/dL) and normal coagulation parameters. After packed red blood cell transfusion and resuscitation, duodenoscopy at 48 hours revealed a live 4-cm long, flesh-colored, tongue-shaped organism in the second part
of duodenum that was gently removed with endoscopy grasping forceps (Fig. 1; Video 1, available online at www.giejournal.org). The organism survived in the external environment for 60 seconds. No other lesions were seen. Stool examination demonstrated eggs of Fasciolopsis buski (intestinal fluke). She was treated with 3 days of oral praziquantel 25 mg/kg and remained asymptomatic during 1 year of follow-up. To our knowledge, this is the first report of F buski presenting as acute upper GI bleeding in a child. Mucosal erosions or ulcers may develop from the ventral sucker. Public awareness, hygiene education, and antihelminthic therapy need to be emphasized in endemic areas. DISCLOSURE All authors disclosed no financial relationships relevant to this publication.
This video can be viewed directly from the GIE website or by using the QR code and your mobile device. Download a free QR code scanner by searching “QR Scanner” in your mobile device’s app store.
www.giejournal.org
Moinak Sen Sarma, MD, Surender Kumar Yachha, DM, Anshu Srivastava, DM, Ujjal Poddar, DM, Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India http://dx.doi.org/10.1016/j.gie.2015.05.030
Volume 82, No. 4 : 2015 GASTROINTESTINAL ENDOSCOPY 743